nep-hea New Economics Papers
on Health Economics
Issue of 2020‒01‒27
twelve papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. E-Cigarettes and Adult Smoking: Evidence from Minnesota By Henry Saffer; Daniel L. Dench; Michael Grossman; Dhaval M. Dave
  2. The Long-Run Impacts of Adolescent Drinking: Evidence from Zero Tolerance Laws By Abboud, Tatiana; Bellou, Andriana; Lewis, Joshua
  3. Health, wealth, and informality over the life cycle By Julien Albertini; Xavier Fairise; Anthony Terriau
  4. A Fuel Tax Decomposition When Local Pollution Matters By Stéphane Gauthier; Fanny Henriet
  5. The 2003 Severe Acute Respiratory Syndrome Epidemic: A Retroactive Examination of Economic Costs By Noy , Ilan; Shields, Sharlan
  6. Social Media Extensive Use and Emotional and Behavioural Outcomes in Adolescence: Evidence from British Longitudinal Data By McNamee, Paul; Mendolia, Silvia; Yerokhin, Oleg
  7. Bayesian estimation of age-specific mortality and life expectancy for small areas with defective vital records By Schmertmann, Carl; Gonzaga, Marcos Roberto
  8. Hospitals' Strategic Behaviours and Patient Mobility: Evidence from Italy By Paolo Berta; Carla Guerriero; Rosella Levaggi
  9. Bringing health care to the patient: An overview of the use of telemedicine in OECD countries By Tiago Cravo Oliveira Hashiguchi
  10. Transition welfare gaps: one closed, another to follow? By Maksym Obrizan
  11. Expanding Health Insurance for the Elderly of the Philippines By Abrigo, Michael R.M.; Halliday, Timothy J.; Molina, Teresa
  12. Menstrual Health, Worker Productivity and Well-being among Female Bangladeshi Garment Workers By Kristina Czura; Andreas Menzel; Martina Miotto

  1. By: Henry Saffer; Daniel L. Dench; Michael Grossman; Dhaval M. Dave
    Abstract: E-cigarettes use a battery powered heater to turn a liquid containing nicotine into a vapor. The vapor is inhaled by the user and is generally considered to be less harmful than the smoke from combustible cigarettes because the vapor does not contain the toxins that are found in tobacco smoke. Because e-cigarettes provide an experience that is very similar to smoking, they may be effective in helping smokers to quit, and thus the availability of e-cigarettes could increase quit rates. Alternatively, e-cigarettes may provide smokers with a method of bypassing smoking restrictions and prolong the smoking habit. There is very little causal evidence to date on how e-cigarette use impacts smoking cessation among adults. Although there is no federal tax on e-cigarettes, a few states have recently imposed heavy taxes on them. We provide some of the first evidence on how e-cigarette taxes impact adult smokers, exploiting the large tax increase in Minnesota. That state was the first to impose a tax on e-cigarettes by extending the definition of tobacco products to include e-cigarettes. This tax, which is 95% of the wholesale price, provides a plausibly exogenous deterrent to e-cigarette use. We utilize data from the Current Population Survey Tobacco Use Supplements from 1992 to 2015, in conjunction with a synthetic control difference-in-differences approach. We assess how this large tax increase impacted smoking cessation among adult smokers. Estimates suggest that the e-cigarette tax increased adult smoking and reduced smoking cessation in Minnesota, relative to the control group, and imply a cross elasticity of current smoking participation with respect to e-cigarette prices of 0.13. Our results suggest that in the sample period about 32,400 additional adult smokers would have quit smoking in Minnesota in the absence of the tax. If this tax were imposed on a national level about 1.8 million smokers would be deterred from quitting in a ten year period. The taxation of e-cigarettes at the same rate as cigarettes could deter more than 2.75 million smokers nationally from quitting in the same period. The public health benefits of not taxing e-cigarettes, however, must be weighed against effects of this decision on efforts to reduce vaping by youth.
    JEL: I12 I18
    Date: 2019–12
  2. By: Abboud, Tatiana (University of Montreal); Bellou, Andriana (University of Montreal); Lewis, Joshua (University of Montreal)
    Abstract: This paper provides the first long-run assessment of adolescent binge drinking on later- life health and labor market outcomes. Our analysis exploits cross-state variation in the rollout of "Zero Tolerance" (ZT) Laws, which set strict alcohol limits for drivers under age 21 and led to sharp reductions in youth binge drinking. We adopt a difference-in-differences approach that combines information on state and year of birth to identify individuals exposed to the laws during adolescence and tracks the evolving impacts into middle age. We find that ZT Laws led to significant improvements in later-life health. Individuals exposed to the laws during adolescence were substantially less likely to suffer from cognitive and physical limitations in their 40s. The health effects are mirrored by improved labor market outcomes. These patterns cannot be attributed to changes in educational attainment or marriage. Instead, we find that affected cohorts were substantially less likely to drink heavily by middle age, suggesting an important role for adolescent initiation and habit-formation in affecting long-term substance use.
    Keywords: Zero Tolerance Laws, binge drinking, disabilities, substance abuse
    JEL: I18 I12 J20
    Date: 2019–12
  3. By: Julien Albertini (Univ Lyon, Université Lumière Lyon 2, GATE UMR 5824, F-69130 Ecully, France); Xavier Fairise (GAINS, University of Le Mans); Anthony Terriau (GAINS, University of Le Mans)
    Abstract: How do labor market and health outcomes interact over the life cycle in a country characterized by a large informal sector and strong inequalities? To quantify the effects of bad health on labor market trajectories, wealth, and consumption, we develop a life-cycle heterogeneous agents model with a formal and an informal sector. We estimate our model using data from the National Income Dynamics Study, the first nationally representative panel study in South Africa. We run counterfactual experiments and show that health shocks have an important impact on wealth and consumption. The channel through which these shocks propagate strongly depends on the job status of individuals at the time of the shock. For formal workers, bad health reduces labor efficiency, which translates into lower earnings. For informal workers and the non-employed, the shock lowers the job finding rate and in- creases job separation into non-employment, which results in a surge in non-employment spells. As bad health spells persist more for non-employed than for employed individuals, the interaction between labor market risks and health risks generates a vicious circle.
    Keywords: Health, Wealth, Life cycle, Informality
    JEL: I14 I15 E26 O17 J46 J64
    Date: 2019
  4. By: Stéphane Gauthier (PSE - Paris School of Economics, CES - Centre d'économie de la Sorbonne - UP1 - Université Panthéon-Sorbonne - CNRS - Centre National de la Recherche Scientifique); Fanny Henriet (PSE - Paris School of Economics, PJSE - Paris Jourdan Sciences Economiques - UP1 - Université Panthéon-Sorbonne - ENS Paris - École normale supérieure - Paris - INRA - Institut National de la Recherche Agronomique - EHESS - École des hautes études en sciences sociales - ENPC - École des Ponts ParisTech - CNRS - Centre National de la Recherche Scientifique)
    Abstract: We study the optimal design of consumption taxes when both global and local externalities matter. Local externalities make the social impact of the consumption of externality-generating commodities varying across consumers. A typical example involves the greater damage caused by pollution from urban fuel consumers. We provide a condition for the validity of the targeting principle according to which externality concerns should only fall on the taxes on externality-generating commodities. When this condition is satisfied, one can decompose the tax on an externality-generating commodity into equity/efficiency and Pigovian contributions. The Pigovian contribution should exceed the average social damage if the fuel consumption of the greatest polluters is more responsive to fuel price. In an empirical illustration we find that the fuel tax in France is mostly explained by Pigovian considerations.
    Keywords: Pigovian tax,targeting principle,local externality,pollution,commodity taxes
    Date: 2018–06
  5. By: Noy , Ilan (Victoria University of Wellington); Shields, Sharlan (Victoria University of Wellington)
    Abstract: The 2003 severe acute respiratory syndrome (SARS) epidemic was the first epidemic of the 21st century to pose a threat to global health and generate considerable panic across the globe. Fortunately, due to the rapid containment of the epidemic, both the harm to the public’s health and economic losses were not as considerable as many feared they might be. After a short period of economic turmoil, lasting a few months, normal patterns of economic activity were resumed. However, during this period there were dramatic reductions in air travel and tourism, and leisure and/or hospitality services in the areas affected by SARS. These losses were driven by public avoidance, which contributed to a disproportionate aggregate disease prevention cost. This has led to concerns that an outbreak exhibiting higher mortality rates could result in a catastrophic impact on the global economy caused by even more drastic behavioral responses. These behavioral responses were related to individual perspectives about the risk of contraction and death, as well as the perceived costs and benefits of disease avoidance measures. How individuals form these avoidance responses has a significant role in determining the pathway of an epidemic. When situating these considerations within the trend of increasing emergence of zoonotic diseases and increasing globalization, analyses of the behavioral reaction to the SARS epidemic are potentially important. With this in mind, critical analysis of government intervention mechanisms is considered to address how cost-effective intervention might alter behavioral responses to lead to more positive outcomes.
    Keywords: epidemic; influenza; panic; SARS
    JEL: I18 Q54 Z32
    Date: 2019–10–07
  6. By: McNamee, Paul (University of Aberdeen); Mendolia, Silvia (University of Wollongong); Yerokhin, Oleg (University of Wollongong)
    Abstract: We investigate the relationship between social media use and emotional and behavioural outcomes in adolescence using data from a large and detailed longitudinal study of teenagers from the UK. To the best of our knowledge, this is the first study in economics to analyse the effect of social media use on adolescents' mental health. We use individual fixed effects, propensity score matching and treatment effects with Inverse Probability Weighted Regression Adjustment, controlling for a rich set of children's and family's characteristics and using comprehensive sensitivity analyses and tests to assess the potential role of unobserved variables. Our results show that prolonged use of social media (more than 4 hours per day) is significantly associated with poorer emotional health and more behavioural difficulties, and in particular decreased perception of self-value and increased incidence of hyperactivity, inattention and conduct problems. However, limited use of social media (less than 3 hours per day) has some positive effect on peer relationships.
    Keywords: social media, mental health, fixed effects
    JEL: I10
    Date: 2019–12
  7. By: Schmertmann, Carl (Florida State University); Gonzaga, Marcos Roberto
    Abstract: We develop a Bayesian regression model for small-area mortality schedules that simultaneously addresses the problems of small local samples and underreporting of deaths. We combine a relational model for mortality schedules with probabilistic prior information on death registration coverage – derived from demographic estimation techniques such as Death Distribution Methods, and from field audits done by public health experts. We test the model on small-area data from Brazil. Incorporating external estimates of vital registration coverage though priors improves small-area mortality estimates by accounting for under-registration, and by automatically producing measures of uncertainty.
    Date: 2018–02–02
  8. By: Paolo Berta (Università di Milano-Bicocca); Carla Guerriero (Università di Napoli Federico II and CSEF); Rosella Levaggi (Università di Brescia)
    Abstract: The aim of this study is to explore hospitals' behaviours in attracting extra-regional patients and to investigate the effects of these behaviours on the quality of care to resident patients in a context where choices by regional patients are constrained by a budget cap and extra-regional patients are unconstrained source of revenue. Empirical results suggest that, controlling for hospital fixed effects, patients' demographic and health characteristics, hospitals use waiting times and length of stay to attract exra-regional patients. Regional patients admitted in both private and public hospitals with higher proportions of extra-regional patients show lower mortality rates and reimbursement costs. These results suggest that competition increases the quality of care and reduces costs through spillover effects produced by the market for extra-regional patients. Finally, the pattern of reimbursement asked for extra-regional care generates a financial flow in favour of richer regions, exacerbating the north-south gradient in the Italian NHS.
    Keywords: Hospital competition, patient mobility, mixed market, quality of care.
    JEL: H51 H77 D6 C70
    Date: 2020–01–23
  9. By: Tiago Cravo Oliveira Hashiguchi (OECD)
    Abstract: Telemedicine is being used across OECD countries to deliver health care in a wide range of specialties, for numerous conditions and through varied means. A growing body of evidence suggests that care delivered via telemedicine can be both safe and effective, in some cases with better outcomes than conventional face-to-face care. Telemedicine services can also be cost-effective in different settings and contexts. However, despite these benefits, these services still represent a small fraction of all health care activity and spending. Important barriers to wider use remain, with providers and patients facing regulatory uncertainty, patchy financing and reimbursement, and vague governance. Due to inequalities in health and digital literacy, patients that most stand to benefit are also often those that are least able to access and make use of telemedicine. Telemedicine has the potential to improve effectiveness, efficiency and equity in health care, but can also introduce new risks and amplify existing inequalities.
    JEL: I1 H51 O33
    Date: 2020–01–21
  10. By: Maksym Obrizan (Kyiv School of Economics)
    Abstract: Respondents from post-communist countries have been found to systematically report lower levels of happiness and self-rated health. While the first welfare gap in happiness has closed recently, the second transition gap in self-perceived gap only started to close. Specifically, this paper shows that treating all transition countries as a homogeneous group may be misleading and divides 28 transition countries into three groups. As result, in the most recent 2016 round of ‘Life in Transition’ survey, transition countries in Southern Europe are no longer different from non-transition nations in terms of their self-rated health. Although the gap in self-perceived health for transition nations in Eastern Europe is present in a basic model, it becomes less statistically and economically significant when subjective beliefs and macro-level variables are added. Countries from the former Soviet Union and Mongolia remain the only group in which respondents report 16.5−29.1% lower probability of ‘Good’ or ‘Very Good’ health compared to other transition and non-transition countries. Controlling for communist party membership, ideological beliefs and macro-level variables somewhat reduces the gap for the former Soviet Union and Mongolia but it remains significant in multiple robustness checks. Although the gap in self-rated health now applies to only one group of transition countries, it remains an important empirical puzzle with far-reaching implications for health policy, demand for health care and the process of transition.
    Keywords: self-rated health, transition gap, Life in Transition
    JEL: I15 N34 P41
    Date: 2020–01
  11. By: Abrigo, Michael R.M. (Philippine Institute for Development Studies); Halliday, Timothy J. (University of Hawaii at Manoa); Molina, Teresa (University of Hawaii at Manoa)
    Abstract: This paper evaluates a Filipino policy that expanded health insurance coverage of its senior citizens, aged 60 and older, in 2014. Using regression discontinuity and difference-in-differences methods, we find that the expansion increases insurance coverage by approximately 16 percentage points. We show that the compliers, those induced by the policy to obtain insurance, are disproportionately female and largely from the middle of the socioeconomic distribution. Instrumental variables estimates indicate that out-of-pocket medical expenditures more than double among the compliers. We argue that this is most likely driven by an outward shift in the medical demand curve.
    Keywords: insurance, medical demand, compliers, Philippines
    JEL: I10 I13 I14
    Date: 2019–12
  12. By: Kristina Czura; Andreas Menzel; Martina Miotto
    Abstract: We conducted a randomised controlled trial (RCT) on a sample of 1,000 female garment workers in three factories in Bangladesh, offering access to free sanitary pads at work to 500 of the workers. We cross-randomised participation in information sessions for hygienic menstrual health care implemented by an experienced local NGO, and we vary the salience of commonly perceived taboos in the pad collection process. We find effects of the free pads and information sessions on self-reported pad use, but not of the taboo variations. We find effects on absenteeism and adherence to traditional restrictive and health-adverse taboos surrounding menstruation, but not on worker turnover or self-reported well-being at work. PRELIMINARY VERSION: The trial is currently being repeated between September 2019 and April 2020, with an additional 1,000 workers to reach the final targeted sample size.literature.
    Keywords: menstrual health; taboos; productivity; export manufacturing;
    JEL: O14 O15 O35 M54 J32 J81
    Date: 2019–12

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